Obese patients increase costs of ICU resources, study finds

Nilufer Hajra, 16 Aug 2017

A recent study revealed patients with higher levels of obesity were four times more likely to require extra time in the intensive care unit (ICU). Photo credit: tctmd.com

In a recent study conducted by medical researchers in Canada, it was found that obese patients undergoing cardiac surgery are considered a greater burden on the intensive care unit (ICU) resource utilisation after the surgery procedure.

The effects of obese patients in the ICU

This study was based on the number of patients, who underwent cardiac surgery at the New Brunswick Heart Centre between January 2006 and December 2013. In the study, 36% of the 5,365 patients were classified as obese.

From the hospital’s logbooks and individual charts, investigators were trying to figure out the impact of obesity on clinical outcomes by drawing out comparisons with patients of normal BMIs.

Compared to patients with a normal body mass index (BMI), it was discovered that obese patients are four times more likely to spend more time in the ICU – and are also three times more likely to be readmitted to the ICU.

As reported by investigators, this overload of obese patients wasn’t a problem 15 years ago. Senior investigator, Ansar Hassan, remarked that “the patients we’re seeing now are definitely a lot different than the ones we saw five, 10, or 15 years ago.”

What happens when the patient is ‘too’ overweight…

The patients are not just a little overweight – they are morbidly overweight, which creates an impact on post-operative ICU resource use. Overweight patients have more comorbid disease than patients with normal BMIs.

Overweight patients also have more severe health conditions, such as hypertension, dyslipidemia, renal failure, and diabetes. When it comes to the effect of after surgery, this study found that there was an in-hospital mortality rate of 1.7% and the average length of stay for these patients were reported to be five days.

Brandon R. Rosvall, the study’s lead author, explained that obesity has become an epidemic because “it is a growing problem for the society.” He elaborated, “We saw that as patients became more obese, the hospital resources required to care for them after heart surgery also increased.”

ICU resource utilisation is used more by patients with obesity than with normal-weight patients. For example, obese patients are more likely to stay in the ICU for more than 48 hours. If ever they are in need of mechanical ventilation, it will be for more than 24 hours.

This study has also found that obese patients are most likely going to end up back in the ICU, which could be due to respiratory failure, cardiac and gastrointestinal complications. Due to these findings, obese patients definitely have a much higher impact on healthcare costs that includes a more expensive, more labor-intensive care.

Commenting on the study’s outcomes, Hassan said, “At the end of the day, these patients are coming to us and as much as we’d like them to be in better shape for their operation – often times we don’t have that luxury.”

As for the cost that it takes to get the ICU running, Rosvall said, “The ICU provides a number of highly specialised services to care for patients who are seriously ill. Expensive resources including staff, medical equipment, and medication are needed.”

Solutions on cutting down costs for the ICU

Since the after-effects of obese patients have to be dealt with by cutting down the burden on ICU resources, this study has also proposed several steps that can help save the cost of health care system – and improve overall patient care, simultaneously.

Hassan suggested that obese patients can be transferred to a stepdown (intermediate) unit, where they will be able to stay for a long period without any interruptions.

This step would also help ensure that obese patients will not be readmitted to the ICU, since the stepdown/intermediate unit includes the convenience of non-invasive forms of ventilation.

Currently, there are other ongoing studies in non-emergent patients to see if losing weight or improving fitness levels might help in reducing complications from surgery. Investigators believe that it’s high time that patients are made aware of the negative impact that obesity brings.

Elaborating more on this, Rosvall expressed that “more in-depth conversations regarding surgical risks and alternatives to surgery should take place with obese patients, so that they are aware of the true impact of increased obesity.”

Health care providers should also assist obese patients on how to achieve and maintain a healthy body weight. Obesity might be a social issue – but it can be addressed on a personal level, if health care providers and patients are willing to work hand in hand to address this issue. MIMS

At the recent Malaysian Community Pharmacy Business Forum (MyCPBF), a discussion forum was held on the subject of “Transcending Primary Healthcare Services: The Future of Specialized Pharmacy Services and Pharmacy Specialization”.